Primary mediastinal large B-cell lymphoma (PMLCL) is an aggressive non-Hodgkin lymphoma with distinct clinical and gene expression profiles. Outcomes of salvage chemotherapy and autologous stem cell transplantation (ASCT) for relapsed or refractory disease (RR) have not been well characterised. We retrospectively identified 180 consecutive RR patients (37 PMLCL and a control group of 143 DLBCL) that underwent salvage chemotherapy. The overall response rate (ORR) to salvage chemotherapy (25% vs. 48%, p = 0.01) and 2-year OS after diagnosis of RR disease (15% vs. 34%, p = 0.018) was inferior in PMLCL patients. The 2-year post-ASCT OS (67% PMLCL vs. 53%, p = 0.78) and PFS (57% PMLCL vs. 36%, p = 0.64) were similar. RR PMLCL had an inferior ORR and survival compared with DLBCL but chemosensitive PMLCL and DLBCL patients have similar outcomes post-ASCT. Strategies for PMLCL should focus on identifying poor risk patients to test novel induction and salvage strategies.

The role of fine needle aspiration (FNA) as a first‐line diagnostic modality is well‐established for neoplastic and nonneoplastic liver masses in adults. However, cytopathologic analysis of such lesions in children and adolescents has not been well studied. An 18‐year retrospective review of the cytopathology archives at The Johns Hopkins Hospital identified 44 cases of hepatic FNA in children and adolescents (i.e., 21 years and younger). The cytopathologic material was reviewed and correlated with subsequent surgical pathology diagnoses and/or clinical follow‐up. Among the 44 FNAs studied, 40 (90.9%) were deemed diagnostic for evaluation and 4 (9.1%) were nondiagnostic. Twenty four (60%) of the diagnostic FNAs were neoplasms, 10 (25%) were nonneoplastic lesions, and 6 (15%) were “atypical” or “suspicious.” There were 21 (87.5%) malignant and 3 (12.5%) benign tumors. Among the malignant cases, metastases/secondary tumors accounted for 12 (54.5%) followed by hepatocellular carcinoma (HCC)—7 (38.1%). The types of metastatic/secondary neoplasms were Wilms tumor (2), germ cell tumor (2), acute leukemias (2), and miscellaneous others (6). Among the nonneoplastic lesions focal nodular hyperplasia was most common—4 (40%). Among the “atypical” cases, 4 (66.6%) turned out to be benign on follow‐up, 2 were HCC, and 1 was Hodgkin lymphoma. Immunoperoxidase (IPOX) studies were done in 20 (45.5%) cases to confirm the cytopathologic diagnoses. Overall, FNA showed a sensitivity of 95.2% and a specificity of 100% for a malignant diagnosis. Diagn. Cytopathol. 2012. © 2011 Wiley Periodicals, Inc.

Summary:We aimed to assess the effectiveness of cyclophosphamide, etoposide and G-CSF (C+E) to mobilize peripheral blood stem cells for autologous stem cell transplantation in patients with lymphoma. A matched cohort study was performed comparing patients mobilized with C+E to patients mobilized with cyclophosphamide and G-CSF (C alone). Patients were matched for disease, prior radiotherapy and a chemotherapy score reflecting the amount and type of prior chemotherapy. Thirty-eight consecutive patients mobilized with C+E were compared with 38 matched controls. C+E was equivalent to C alone in terms of numbers of patients achieving a minimum threshold of у2 ؋ 10 6 /kg CD34 + cells (82% vs 79%, P = 0.74). C+E was superior, however, in terms of total CD34 + yield (6.35 vs 3.3 ؋ 10 6 /kg, P Ͻ 0.01), achieving a target graft of у5 ؋ 10 6 /kg (55% vs 34%, P = 0.04) and obtaining both a minimum (61% vs 32%, P Ͻ 0.01) and target (45% vs 13%, P Ͻ 0.01) graft in one apheresis. This superiority was largely confined to patients with lower chemotherapy scores. There was no difference in neutrophil and platelet recovery or transfusion requirements for those who subsequently received high-dose therapy and stem cell transplantation. Thus, C+E improves the efficiency of peripheral blood stem cell collection, but does not increase the number of patients who can proceed to transplantation. Most of the benefit of the regimen was confined to patients who had not received extensive prior therapy. Novel strategies are required to increase the collection efficiency of 'hard to mobilize' patients. in patients with lymphoma. Engraftment following transplantation of PBSCs is more rapid than with bone marrow 1 and has been demonstrated to correlate best with the number of CD34 + cells in the graft. With standardization of CD34 + enumeration, 2 у5 ϫ 10 6 /kg CD34 + cells has been suggested as a reasonable target for PBSC collection, as this allows optimal engraftment in nearly all patients. [3][4][5] Alternatively, transplantation of Ͻ1 to 2 ϫ 10 6 /kg CD34 + cells has been associated with delayed and failed engraftment, 6-10 leading to the concept of a minimum threshold CD34 + count in order to safely proceed with ASCT.Optimizing PBSC collection remains an important goal for several reasons: to increase the proportion of patients who can proceed to ASCT; to reduce the time to hematopoietic recovery post transplant; to maximize the efficiency of the PBSC collection process given the morbidity and costs of apheresis; and to reduce the need for second mobilizations and bone marrow harvests. Several studies 5,11-14 have described factors influencing the yield of PBSCs, including age, diagnosis, marrow involvement, prior radiation and time from prior chemotherapy therapy, but amount of previous chemotherapy seems to be the most consistent. The prior use of stem cell toxic regimens or agents such as nitrogen mustard, procarbazine, melphalan, carmustine, high-dose cytarabine, 15 Dexa-BEAM 16 and mini-BEAM 17,18 result in poor and unpredictable mob...

BackgroundThe use of high-dose chemotherapy and autologous stem-cell transplantation in patients with relapsed Hodgkin's lymphoma is supported by two randomized clinical trials but its benefit in patients with primary refractory disease is less clear. Aiming to shed light on this issue, we analyzed and compared the outcomes of patients with relapsed or refractory Hodgkin's lymphoma treated with second-line chemotherapy and planned autologous stem-cell transplantation. Design and MethodsWe retrospectively analyzed data on 157 consecutive patients with Hodgkin's lymphoma referred to our institution for consideration of autologous stem-cell transplantation between 1999 and 2006. Of those, 73 met the definition of having primary refractory disease, ie. progressive disease during first line chemotherapy or within 3 months of completion of the treatment. Those patients achieving complete remission, partial remission and stable disease with symptomatic improvement after two or three cycles of salvage chemotherapy proceeded to stem cell mobilization and autologous transplantation. ResultsFrom first relapse/progression, the 3-year overall survival was 76% (95% CI: 66%-89%) for the refractory cohort and 91% (95% CI: 84%-98%) for the relapsed cohort (P=0.034); the overall response rate to second-line chemotherapy was 51% and 83% (P<0.0001), respectively. Threeyear progression-free survival post-transplant was 49% in refractory patients and 67% in relapsed patients (P=0.21); overall survival was 75% and 91% (P=0.097), respectively. ConclusionsUsing the group with relapsed disease as a reference, we can conclude that the subset of patients with chemosensitive primary refractory Hodgkin's lymphoma do benefit from autologous stem-cell transplantation.Key words: Hodgkin's lymphoma, transplantation, refractory.Citation: Puig N, Pintilie M, Seshadri T, al-Farsi K, Nagy T, Franke N, Tsang R, Keating A, Crump M, and Kuruvilla J. Different